The Blue Girl

Heart Hospital, Hamad Medical Corporation, Doha, Qatar *Email: [email protected] Memories of my early years of establishing cardiology service from scratch in Qatar are still fresh and clear in my mind. Some cases are hard to forget because of the interesting social and human elements surrounding them. One such case was that of an Egyptian girl whose fate brought her to Qatar over 30 years ago because of cyanosis. In June 1980, our cardiology section in Rumailah Hospital was two years old. By that time, we had acquired electrocardiography, phonocardiography, and M-mode echocardiography machines. We did not have a proper catheterization laboratory but we managed to do right and left heart catheterization in a room in the coronary care unit (CCU), using a CCU monitor and a small portable fluoroscopy machine attached to a video recorder. We used a portable x-ray machine to record one image at a time on a film to clarify or document a lesion of a coronary vessel by injecting a contrast agent, then quickly shoot a picture. We may have had to repeat such shooting because it gave us better images than our primitive video recorder. With this technique we were able to make a reasonable diagnosis for most adult cases. Pediatric cardiac cases were problematic for me then because I was only trained to be an adult cardiologist. I only spent two months rotation in pediatric cardiology during my cardiology fellowship training in the USA at the University of Oregon in Portland, Oregon. After we moved from Rumaillah Hospital to the new Hamad General Hospital in 1982, I had to do a few simple cardiac catheterizations on children without enthusiasm. Therefore, we used to send most Qatari pediatric patients abroad for diagnosis and therapy until Dr. Gordon Folger, a senior pediatric cardiologist joined us in 1984. Dr. Folger was a very experienced American pediatric cardiologist with excellent qualifications. He underwent pediatric cardiology training at Johns Hopkins Hospital under the supervision of the late Helen B. Taussig, a world-renowned pediatric cardiologist. Dr. Folger established the pediatric cardiology section at Hamad General Hospital. I used to call Dr. Folger ‘‘the old man’’ because he was the most senior member of our department. At first he protested, but later he accepted it with grace when he realized that such a title was a sign of respect in our society. During the early 1980s, my friend Dr. Gelal El-Said, a well-known Egyptian cardiologist, used to give us priority on his trips outside Egypt. Dr. El-Said is a senior cardiologist with excellent knowledge of both adult and pediatric cardiology. He is a first class clinician and teacher. During his visits, we would present to him pediatric cases referred to us. If the number of pediatric cardiac cases were small for discussions, he used to go to the pediatric ward, talk to the pediatricians about patients with murmurs in their ward, and add new cases for our meetings. He was keen to teach. In June 1980, during one of Dr. El-Said’s visits to our department, the pediatricians presented an interesting patient during one of our cardiology conferences. The patient was a 14-year old Egyptian girl with cyanosis (i.e. blue lips and blue fingers). She was seen a couple of years earlier in Egypt by general practitioners who labeled her as a case of cyanotic heart disease. Her father, a university professor, had consulted a cardiac surgeon in Egypt. The surgeon recommended surgery for the little girl but the father could not afford the cost of surgery. He decided to seek employment in the Arabian Gulf to improve his income in order to save enough money for his daughter’s surgery. He ended up teaching at the University of Qatar in Doha. The patient was being followed up in the pediatric department in Rumailah Hospital for two years as a case of congenital cyanotic heart disease and recurrent pneumonia. During those two years she was hospitalized several times for cough and ‘‘pneumonia’’. On each of her several admissions, the radiologist reported her chest x-ray as ‘‘acute pneumonia’’. Her CBC revealed polycythemia. The